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General NPI Number Information
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NPI Number | 1861187429
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Entity Type | Organization
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Legal Business Name | MATTHEW L BONEY
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 113 SOUTH WRIGHT STREET
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City | BURGAW
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State | NC
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Zip | 28425-2842
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Country | US
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Telephone | 336-706-7625
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Fax | 910-259-7464
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Provider Business Mailing Address
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Address Line | PO BOX 1744
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City | BURGAW
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State | NC
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Zip | 28425-1744
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Country | US
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Telephone | 336-706-7625
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Fax | 910-259-7464
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW LA TOURA BONEY
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Credential | ESQ
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Telephone | 336-706-7625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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